Women Need More Help After Heart Attack

TUESDAY Feb. 16, 2010 -- Women are in greater need of social support in the critical year after a heart attack than men, new research shows.

The study of 2,411 people treated for heart attacks at 19 U.S. medical centers found that both men and women who received the least support from health personnel, families and friends did worse on a variety of measures, according to the report in the March issue of Circulation: Cardiovascular Quality and Outcomes, which is a theme issue on women and cardiovascular disease.

"We were looking at a number of outcomes that are important for individuals, rather than just whether they die or remain hospitalized," said Judith Lichtman, associate professor of medicine at Yale School of Medicine, a leader of the study. "We saw that lack of social support inhibits quality of life."

Men and women with the lowest level of social support had a higher risk of chest pain, worse mental functioning and more symptoms of depression. But the association between social support and general health was stronger for women than for men, she added.

"One goal of the study was to identify that there is a difference between men and women," Lichtman said. "It could be that men and women are coping differently after having a heart attack."

The source of social support is less important than just "having someone available to provide advice, love and affection, to talk with you and help make decisions," Lichtman said. "It could be a combination of family members, friends and caregivers."

Because women generally live longer than men, they are less likely to have a spouse or other male partner to provide support, she added. "Older women should look to other family members," Lichtman said. Children can help, but when there are no children, "friends can be part of the rehabilitation process, and there are other ways to enhance support," she said, such as rehabilitation programs.

The study results "should help raise the awareness of care providers about what kinds of clinical intervention are necessary and the need for social contacts," Lichtman said. "It should help us target interventions to improve social support, not only by clinicians but also by family and friends."

Another study in the same issue of the journal showed that while heart disease is the leading cause of death in women as well as men, women made up only 30 percent of the patient population in the 156 randomized trials cited by the American Heart Association's 2007 guidelines for cardiovascular disease prevention in women. And only one-third of the trials reported gender-specific results.

There is no simple explanation for the lower inclusion of women in clinical trials, said Dr. Chiara Melloni, an assistant professor of medicine at Duke University and the lead author of the report.

"There are many possible explanations," Melloni added. "Women could be less willing to participate, and there could be some bias against women for inclusion."

One possible factor is that women tend to have heart disease later in life than men, Melloni said. "If you exclude older patients from a study, you are more likely to exclude women," she explained.

But there could be a "social factor," she also noted. "Women are sometimes less aware of cardiovascular risk than men."

More information on women and cardiovascular disease are needed, and steps are being taken to improve the situation, Melloni said. Both the U.S. National Institutes of Health and the U.S. Food and Drug Administration have taken steps to increase the number of women in clinical trials, she noted.

A third paper in the journal outlined a simplified strategy for predicting women's cardiovascular disease risk. The most commonly used strategy, based on findings of the Framingham Heart Study, requires assessment of seven known risk factors, including high blood pressure, obesity and blood cholesterol levels.

The new method starts by labeling women with known cardiovascular disease or diabetes as "high risk," with a 12.5 percent chance of a heart attack or death in the next 10 years. Women with at least one major risk factor, including smoking, physical inactivity or a high-fat diet, are listed as "at risk," with a 3.1 percent chance of an event in the next decade, while those with no risk factors are "optimal risk," with a 1.1 decade-long chance of an event.

"One of the advantages of the guidelines we are assessing is that it is easier to do the calculation," said Dr. Judith Hsia, who began the study as a professor of medicine at George Washington University and now is senior director of clinical research at the pharmaceutical company AstraZeneca.

When the method was applied to the 161,808 participants in the Women's Health Initiative, 11 percent were classified as "high risk," 72 percent as "at risk" and 4 percent as "optimal risk." The other 13 percent couldn't be classified for various reasons.

"This method doesn't give you a numeric value," Hsia said. "It just tells you whether you are at risk. You have to take the result to your health care provider and say, 'Am I at risk? Is there anything I can do about it?'"

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